Obstructive sleep apnea, positive airway pressure therapy, and COVID-19 outcomes.

PURPOSE: To quantify the association between obstructive sleep apnea (OSA) and COVID-19 outcomes and test whether adherence to positive airway pressure (PAP) therapy modifies this relationship.

METHODS

This retrospective cohort study compared groups with and without OSA, stratified by degrees of PAP adherence (February 1, 2020 to July 31, 2020) from an integrated healthcare system (Kaiser Permanente Southern California). Rates of COVID-19 infection and hospitalization were compared. Multivariable logistic regression estimated adjusted associations, controlling for demographic and clinical factors.

RESULTS

Among 78,317 patients analyzed, a pattern revealed increased COVID-19 infection rate in those with OSA and decreased with PAP therapy: No OSA 1.9%; Untreated OSA (PAP use < 2 h/night) 2.2%; Moderately-treated OSA (PAP use 2–3.9 h/night) 1.9%; Well-treated OSA (PAP use ≥ 4 h/night) 1.4% (P < 0.0001). In adjusted models (reference: untreated OSA), odds of infection were lower for patients without OSA (aOR 0.83, 95% CI 0.71–0.97), similar with moderately-treated (2.0–3.9 h/night; aOR 0.88, 95% CI 0.70–1.12), and lower with well-treated OSA (≥ 4 h/night; aOR 0.71, 95% CI 0.62–0.82). Compared with White patients, Black and Hispanic patients had higher odds of infection (aORs 1.46 [1.21–1.77] and 2.14 [1.89–2.43]) and hospitalization (2.02 [1.22–3.35] and 1.66 [1.12–2.46]), highlighting disparities. Neither OSA nor PAP use appeared to influence COVID-19 hospitalization rates, although overall incidences were small.

CONCLUSIONS

OSA was associated with higher risk of COVID-19 infection, whereas greater PAP adherence was associated with lower risk, suggesting potential pathogenic effects of untreated OSA and protective effects of PAP.